Service de Chirurgie Orthopédique, CHU de Limoges, Centre Hospitalier Universitaire de Limoges, Limoges, France.
Unité de Chirurgie Plastique des Membres, de la Main et des Brûlés, CHU Grenoble, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Sud, Grenoble, France.
Orthop Traumatol Surg Res. 2020 Sep;106(5):819-823. doi: 10.1016/j.otsr.2020.03.026. Epub 2020 Jun 27.
Large cutaneous defects exposing the whole tibial crest are difficult to cover and are conventionally best treated with free flaps. This article describes a technical modification of the adipofascial flap in this indication.
The "flip-flap" is vascularized by the posterior tibial artery perforators harvested on the medial aspect of the leg. The hypodermal and fascial tissue is de-epidermized and elevated from the posterior midline up to the medial edge of the soleus muscle, then folded over the exposed tibial crest like a page of a book.
A 27×6cm effect was successfully covered on a 72 year-old patient with vascular status precluding free flap. The flap healed by day 21.
DISCUSSION/CONCLUSION: This technical modification is simple and allows coverage of large tibial crest skin defect when a free flap is not possible.
暴露整个胫骨嵴的大面积皮肤缺损难以覆盖，传统上最好采用游离皮瓣进行治疗。本文描述了这种情况下脂肪筋膜皮瓣的技术改良。
“翻转皮瓣”由小腿内侧采集的胫后动脉穿支血管化。将皮下组织和筋膜从后中线向上掀起至比目鱼肌的内侧缘，然后像书的一页一样对折覆盖暴露的胫骨嵴。
一名 72 岁的患者血管状况不适合游离皮瓣，我们成功地用 27×6cm 的皮瓣覆盖了 27×6cm 的创面。皮瓣在第 21 天愈合。
讨论/结论：这种技术改良简单，可以在无法使用游离皮瓣的情况下覆盖大面积的胫骨嵴皮肤缺损。
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